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� <br />A licant I�fo�n�ation <br />Ja��s R. Hup�, �lssistant Sec�etary <br />Applican� �ame: on be�a� f of ��l � day Stati onst�res , I�c . <br />�o�e A�dress: <br />Phone N�mber: <br />5422 Grand �ve S <br />Min�ea o��s MN 5�419 <br />Da% of B�rt1�: � �- - Place o� ��rth: '-. �� <br />Mi�nesota �Zeside�i: �l Yes <br />� �o; Indicate State of Residence: <br />LTnit�d States Citizen: � Ye� <br />❑ �o <br />If natural�ze�, state and p�ace af naturaliza�io�: State; <br />Place: <br />Spo�se Na�ne: �la�� �urk� Hu <br />Home 1�t�dress: 5422 �ra�d Av� S <br />Mi�nea�o�is MN 55419 <br />Has applican� or any �.ssociate in the application ever been �ejected a liquor license by any <br />mur�icipality or staie a�thori�ty`? <br />❑ No <br />�7 Yes; �x�lain: becau�e of 1 oca� i ss��s � nvo� v� n ' ' �.� � ocati on <br />._._._....._..__....__.__,.._..___..._...__..._._._....__._ ..............._...._._...__._.._..........._.... �._.._._..._.............._.... �._......g..._..�. � �..__.� f _..:�.am�.n �.. i�.._.. <br />Has a�plica�t or �.ny associate in the app��catio� ever been convic�ed of any �iquor lavv viola��on <br />or any crirn� i� t�iis state, or any ot�er state, or under federal lav�s? No , f o r� n d i v i du� 3 o�f i ce rs - <br />Ho� i day Stat� or�stores , I r�c .,� ts su�si d� ar� es a�d affi � i ates o�vn�o erate over 300 <br />convenience s�ores as�l��e sia�� ' � <br />� l�� . I9 . o�s �n 10 sta�es, most of vvhirh ar� ��ce�set <br />to se� � al c��o3 ��_beverages .�ol � day and/or � ts er�i���o��es have b,ee� c� tec� for <br />D Yes, G�v� State and details. sa� es of a� cohol to �� no� c�-� ���_��s . <br />Has applicant or ar�y associate in the application �een a rnernber of t�e governing body of the <br />�un�cipali�y in which this �icense is �o be issi�ed? <br />� I�o <br />�3 Yes; In w�.at capacity: <br />201fl City Liquor �,icense Application <br />Page 2 of � S <br />